Spinning Brushes to Clean Your Face, a review of these home devices

Home microdermabrasion, spinning brushes (Clarisonic, etc.) are very popular right now.  Even the ProActiv info-mertial acne treatment system, added a spinning brush to their line.  So what is the deal with these brushes? Do they work?  There are a handful of mostly biased studies on home microdermabrasion devices, published by the manufacturers of these devices that show exfoliation and mild improvement in texture and tone of the skin, but not the more significant improvement seen by stronger in-office procedures like Clear and Brilliant, Chemical peels, Fraxel Restore.  Gentle exfoliation is helpful to improve acne, melasma, brown spots, and even fine lines/wrinkles.

Some patients of mine have reported that their acne or skin got worse after using the brush.  A possible reason for this, is that they are supposed to exfoliate and are often paired with exfoliating cleansers, so it is possible that acne that was deeper down in the dermis may begin to surface in the first few weeks of treatment.  I would recommend not judging the brush until you have done a trial of it for at least six weeks.   In addition, I have heard concerns from other dermatologists that the brush is grinding dirt and bacteria deeper into the skin and this may trigger more inflammation and acne.  There is just not enough data to support or dispel that notion.  So, until there is, I suggest pre-cleansing prior to using your brush with an exfoliator.  For example, washing with a gentle liquid cleanser like Cetaphil or CeraVe before starting the microdermabrasion routine.

Lip Augmentation

As we age our lips will thin and the distance from the underside of our nose tip to our upper vermilion (red portion) lip, also called philtrum, lengthens.  In women, all of this tends to age and even masculinize our face. 

The philtrum can be shortened and the lip plumped slightly to rejuvenate and feminize and even give more sensuality to the lip.

The most permanent way to achieve shortening of the philtrum and more vermilion show, is with a surgical lip lift, which is done by some cosmetic surgeons. 

A quick, natural, and shorter term way to shorten the philtrum and plump the lip would be to have a filler treatment, usually a hyaluronic acid filler or silicone.  The hyaluronic acid fillers may last 1-2 years depending on the brand, and are reversible with an enzyme called hyaluronidase.  This treatment varies in cost from $500-$1400 depending on Brand of filler, and quantity. 

Laser Treatment of Rhinophyma type of Rosacea

Actual Patient with progressive worsening rhinophyma, before and after a single laser treatment.

 

 

Rhinophyma is a complication of rosacea that is marked by enlargement of the nose, and change in color and texture to include redness, prominent veins, and plugged pores.  It tends to be worse in men and worsen gradually over time.  While we don't have a perfect cure for rosacea and this complication called rhinophyma, we can do alot to control it and improve it.  This treatment was done by me with the Erbium/CO2 resurfacing laser in one session, using local anesthesia.  With this treatment, there is about two weeks of healing with crusting/peeling/inflammation but one can work or do normal daily activities during this time.  Sun avoidance is crucial while healing and indefinitely thereafter b/c sun is a prime trigger of rosacea.  This is a lasting improvement;  however, not a cure for rhinophyma, and it can recur slowly if the person is genetically susceptible or fails to avoid the rosacea triggers like sun and certain foods.  For more information about rosacea triggers and prevention, I recommend going to www.rosacea.org

Under-eye bags and rolls

I treat undereye bags permanently with lower lid laser blepharoplasty, which is the ultimate solution for people who have under-eye bags where there is a fat bulge.  For those who have swelling, or edema causing their under-eye bags, there is a new product made by Living Proof, called Neotensil, which is a polymer which temporarily but quite effectively reduces the undereye puffiness.  It is like putting a hammock for your undereye bags.  Some of my co-workers tested the product and reported high satisfaction, and no complaints of any irritation or strange sensations.  It is also possible to use the product for the under-eye roll (banana or jelly roll) some people have from strong under-eye muscle contraction with expression.  I also like to treat this problem with Botox which helps relax the muscle. 

                                                            This photo is from the Living Proof Neotensil product brochure, from Obagi Medical.

Brows: To Be or Not to Be ?

   Brows are very important for maintaining a youthful, attractive look.  I see alot of female patients at my office that have thinned or almost absent eyebrows from either overplucking, thyroid problems, hormone changes, aging and genetics.  There has been an overplucking trend in recent years that likely originated from a woman's desire to enhance the lateral arch of their brows.  Thinned or barely visible eyebrows can instantly age a person, not to mention look unnatural.  When we first meet a person or begin speaking with a person (whether we know them or not) there are psychologic studies that show the first place we look is the eyes, nose and mouth soon follow.  The eyebrow accents the eye, and is very important as a beauty enhancer. 

  That doesn't mean you should immediately go and paint the eyebrows in.  I have seen brows that have been painted or tattooed-in and look equally strange as if they were absent.  If you do pencil or tattoo them in then be careful to do only as dark as the roots of your hair or the darkest shade of hair on your head, and try not to over thicken them.  In addition, if you're hair is thinned or absent I would consider hair recovery or replacement with either minoxidil or NeoGraft (see below).  Overdone, overthick or too dark eyebrows not only look unnatural but masculinize the face.  Please see my post on permanent make-up, and celebrity weekly featuring Khloe Kardashian for more tips.  If you are losing eyebrow hair for whatever reason, there are some other options that can be tried.  One:  try minoxidil (Rogaine) liquid sparingly twice a day to the face.  This is off-label, may not work, and could irritate the skin so use with caution.  Two:  try NeoGraft eyebrow hair transplant.  It's a permanent solution to the problem, requires monthly trimming (hair comes from head) and may cost $2500 or more.

Enhancing your arch is still advisable to give your eyes a more open and awake appearance, but do it gently and cautiously with limited plucking under the lateral brow where you have a natural arch.
 

Hair-Free at Last, thank God almighty I am hair-free at last

We have come a long way since the 60's and 70's.  Women are now "hairless from the eyebrows down," as Jonah Hill's character in the "Wolf of Wall Street" recently put it.  A current issue of Cosmopolitan proposed the theory to explain this hair-free phenomenon as due to porn stars being bush-free, and the indirect pressure women may receive from their boyfriends or spouses to emulate this look.  Some advocates will profess the beauty and cleanliness of less hair, and others will argue that it adds a strange, juvenile look.  On a positive note, it seems it may be a way for adults to look and feel younger.  While I am not necessarily advocating this look, I don't think it causes any significant health problems except maybe a little less protection from chill when it's cold out.

If you are ready to embrace this look, here is my advice regarding the options available to remove the hair.  If you are committed long-term to being hair-free, do not try shaving alone because you may struggle to keep up and suffer lots of razor bumps in the process.  Waxing may last a little longer and when done well may give fewer bumps and less irritation than shaving. 

Ideally, laser hair removal can be done for permanent "thinning."  What does "permanent thinning" mean?  Most of the hairs do go away in a dark haired person with lighter underlying skin, but there could be a few stray stubborn hairs remaining even after the suggested 6 treatments.  Some locations are more stubborn than others, or more resistant to the laser, especially areas where the hair growth cycle is slower, such as upper lip and chin.  I have treated darker skinned patients, and it is done the safest with the Yag laser (not Alexandrite).  Safe meaning the laser is able to distinguish the hair from the dark skin and not cause too much burning or irritation.  The Yag laser is more painful than Alexandrite and Diode, but it is possible to make the procedure more tolerable with use of cold gel, cold air, and/or numbing cream.  In-office prescription numbing cream (usu. 5-6% Lidocaine) tends to be much stronger than over-the-counter, and is not safe to use in large skin areas. 
 

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Dr. Karen Stolman of Gateway Aesthetic Institute and Laser Center

Dr. Karen Stolman of Gateway Aesthetic Institute and Laser Center

by Dori Cooperman March 7 2014

I was passing through Salt Lake City for the Sundance Film Festival recently and was invited to visit the Gateway Aesthetic Institute and Laser Center where celebrity Dermatologist and Blogger Dr. Karen Stolman practices in the world’s largest cosmetic devoted laser center. The office is crazy elegant and has a gallery of paintings lining the halls.
She specializes in cosmetic medical care beyond just Botox and Fillers, though I did get a Botox/Filler touch up while I was there. Her office, founded by Dermatologist, Dr. Mark Taylor has over 48 devices including one of my favorite finds, the first Cellucurve in America – weight loss bike (imported from Italy), see my pic. I know I may not be a poster-child for weight loss, but some of my friends are. It speeds your aerobic metabolism of fat as you do low impact biking, by shining warm infrared lights. Patients may test ride the bike no charge, or sign up for multiple sessions – 3-5 per week. If you want to order your own bike, at an estimated $100,000, they will arrange that too, but you may want to wait until the Italian manufacturer upgrades the bike next year to include a wrinkle treatment. They showed me all the ways in which you can fix your wrinkles, scars, brown and red spots and fat pockets.
Patients fly in from all over the world, stay at the Grand America Hotel, have their treatment which is usually priced better than in another bigger city like LA or NY. You’ll be advised to not smoke or drink, and to only watch funny movies, but not because you are in Utah, you will heal much faster post-procedure if you follow those steps and live like a Mormon for a little while.


See www.gatewaylasercenter.com (site) and www.guapapo.com (blog)

                                                

 

 

 

                                                    

                                                    

 

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Permanent Makeup tips

I often get asked to recommend a permanent makeup artist, and I have even recommended some of my patients consider permanent makeup.

The popular SofTap brand and method of permanent makeup tattoo is actually semi-permanent and tends to fade in 2-4 years requiring touch-up or new treatments periodically.  So the commitment is not truly permanent, which I like.  What I like about the SofTap method is it can be done with a natural feathered hair look for filling in eyebrows.

Having a tastefully done thin upper and lateral lower eyelid liner can be a time saver for a busy woman. 

As women age, our lateral brows tend to thin and some of us seem to be left with no eyebrow hair by the time were over 50.  I recommend for this either NeoGraft hair transplant to the thinned eyebrows and/or permanent makeup.  If there is very little hair, and permanent makeup is done alone, sometimes it may look less natural, than if a combination (which I prefer) of hair replacement (transplant) and permanent makeup is done.

Some of my older patients, have trouble putting on makeup themselves because of poor vision or unsteady hands, but still want to look their best.  That's when I recommend they consider permanent makeup.  In addition, regular makeup can smear and fade easily which can be frustrating, whereas permanent makeup can be relied on to always look perfect.

I caution to avoid very dark lip liner colors, which tend to look unnatural and even odd.

FAQ's
Is it truly permanent?
No, not exactly.  I like to call it "semi-permanent".  The darker the color you choose the longer it will last it seems, but many people need touch-ups in 2-4 years.

Can I remove the makeup?
Yes, you can remove it with laser, but it will take multiple treatment session 4-15 depending on the color.

Does it hurt?
Yes, a little, unless you have really good numbing cream on, which I recommend.  It is common to have mild swelling, redness and pain for a few days after at your treatment sites.


If you are looking for a great permanent makeup artist, ask your local cosmetic dermatologist for a referral.

 

Pumas, Cougars, Jaguars, Manthers, and how looking younger can be a double-edged sword

When an older man is seen dating or marrying a much younger woman...some derogatory literary phrases come to some minds like trophy wife, gold digger, bald digger, sugar daddy, manther etc.

When an older woman is seen flirting, dating, or marrying a much younger guy...puma, cougar, jaguar, even gerbil (heard on SNL).

While I like to think these animals are attractive and even sexy, they are also aggressive predators.  Bottom line they're all pretty negative references.

I propose that at least the newer fashion of older women linking to much younger guys may have something to do with our progressing cosmetic technology where we are now capable of looking younger and more healthier than in the past.  There are biologic studies to explain that men have an instinctual attraction to a healthy, fertile women.  Looking younger may translate to healthier and more fertile to the eye.

While looking younger and more healthier can be fun in the dating world, it can have mixed outcomes in the workplace.  It is commonly known that looking younger and healthier will help one get hired and keep many jobs; however, I would suggest that in the white collar professional world it may interfere with one's ability to be taken seriously.  If you have no wrinkles or gray hair to show your maturity, will you be trusted to perform your work with the experience of a senior employee?  On the other hand, if you look older, you may give the impression of being tired, drained or even outdated.

I suggest that you look younger, healthier but show your knowledge and experience with hard work, charisma, and professionalism.

Why Tumescent microcannula Liposuction ?

I often get asked why do tumescent microcannula liposuction and how is it different than other liposuction surgery?

Tumescent liposuction is when liposuction is done with smaller suction cannulas under local anesthesia with a dilute Lidocaine:epinephrine mix that allows for slight inflation or tumescing of the treatment area as well as excellent bleeding/bruising control.  The inflation or tumescing is helpful in aiding safe removal of fat and avoidance of surrounding structures.  Dermatologists perfected the tumescent liposuction technique over the past couple decades and have demonstrated that it is consistently safer with a much lower risk of complications compared to liposuction done with general anesthesia.  In addition, years of successful tumescent liposuction have exposed the comparative dangers of liposuction done with general anesthesia. Such dangers include infection, respiratory depression, hemorrhage, DVT/pulmonary emboli and more which are rarely seen with the tumescent technique but a significant risk with general anesthesia technique.

To improve efficiency of fat removal and skin tightening, many dermatologists will use lasers during the liposuction procedure.  I like the SmartLipo and VaserLipo devices for these purposes.  They have allowed us to do hi-definition liposuction such as recreating the six-pack in a man's abdomen, as well as tighten loose skin after fat removal.

Neck wrinkles

Sometimes we focus too much on fixing our face and forget the neck which has suffered almost as much sun damage and aging changes.

What can be done to rejuvenate the neck?

A new cream from Revision Skincare called Nectifirm is promising for home use - see pic below.  It contains a unique natural wrinkle-fighter ingredient from "wax myrtle shrub" plant called dihydromyricetin as well as other know wrinkle-fighters called oligopeptides.  I like this product as a compliment to our in-office neck wrinkle and neck tightening treatments.

In the office, the radiofrequency, ultrasound devices and lasers can be used to improve wrinkles and sagging.  I find the laser tightening with our Fotona NdYag requires fewer treatments than radiofrequency or ultrasound.  The Yag laser will remove hair too, so not appropriate for men who want to keep their beards. In addition, for people who have pockets of fat under the chin.  I may consider Lipodissolve injection or tumescent liposuction.

When you have neck wrinkles and freckles, the Fraxel Restore Dual or Repair are helpful too.

 

Vaginal Rejuvenation

Why vaginal rejuvenation?

It is for various purposes including:  cosmetic improvement of saggy or wrinkly labia skin, for tightening of vaginal canal to improve stress incontinence or sexual function improvement. 

Many women start to experience these changes after pregnancy or with age.

Yes, one option is to have surgical correction, but why do surgery if there is a treatment method that may produce similar results with lower risk, lower downtime, and less expense?
Laser vaginal rejuvenation and treatment of stress incontinence is a cutting edge treatment that has already taken on in Europe and Asia. 

We are currently conducting a study at Gateway Aesthetic Institute (in Utah) and recruiting women who have either stress incontinence or desire to cosmetically improve their vagina as described above, where we will do a brief 20 minute or gentle Yag (1064nm) laser treatment intravaginally and/or externally to the vaginal labia.  We have been told by the laser manufacturer (Fotona Yag) that we are the only physicians in the western U.S. with training and equipment for this procedure.  The treatment will feel warm but not painful, and in fact does not require anesthesia whatsoever.  It may need to be repeated for total of 2-3 treatment sessions a month apart.

 

Old Hands and how to rejuvenate them

So you're face and neck look good, but you forgot the hands.

Here are my suggestions, starting with at home treatments.  Try a retinol cream every night and/or a brown spot lightening cream such as Lytera, Ellure or Melanolyte.

At the office, I suggest treatment of the brown spots with either IPL or laser depending on your skin type.  A few treatment sessions may be necessary.  Another newer option is the Fraxel Restore Dual laser which removes both brown spots and fine wrinkles in one session.  For more severe wrinkles or thinned skin with prominent veins, filler treatment with Radiesse or a hyaluronic acid works great too.

Fat Transfer vs. Fillers to the Face for rejuvenating

This is an ongoing debate among plastic surgeons and dermatologists who perform these procedures.  We offer both of these in our office, but in recent years favor hyaluronic acid fillers for facial rejuvenation over fat transfer.  Fat transfer is more surgically invasive with a higher risk of complications including infection and scarring.  In the past with only collagen fillers available fat transfer to the face may have been superior and longer lasting, but now we have HA fillers like Voluma that last 2 years and stimulate new long-lasting collagen.  That being said, sometimes the decision should involve weighing the skill of the physician.  Some physicians are more skilled at fat transfer vs. fillers, so despite the lower long term risks of fillers they may get better results with what they are most skilled at.
 

Under eye dark circles and veins

I get asked a lot by my patients how to improve their under eye circles and veins.

Some of us have dark under our eyes all our lives for hereditary reasons.  I have even seen some teenagers with hereditary prominent and unsightly under eye veins.  Sometimes it can be acquired or exacerbated by allergies, sinus congestion and lack of sleep.  In addition, with age and sun we can get thinning and wrinkling of the skin along with spider veins under the eye.

We used to not have a good, safe treatment for this problem, other than make up concealers and creams that contain vitamin K which never seemed to work very well, except maybe a new one called Teamine cream (Revision SkinCare) - see pic below.  My associate at Gateway Aesthetic Institute in Utah, Dr. Mark Taylor, recently published (now a year ago) one of the first reports of successful treatment of unsightly under eye and around the eye (periorbital) spider veins with the NdYag 1064nm  laser.  I have since been successfully treating this in people of all ages and skin types, but with caution and very good eye protection.  I must emphasize that Dr. Taylor and I are board-certified dermatologists and laser treatment experts and can do this treatment safely.  The NdYag laser can be a tricky laser to use well and safely.

In addition to treatment of the spider veins around the eyes, we also will treat the darkness and/or redness of this under eye area with careful use of our IPL(Intensed Pulsed Light) device.

Both treatments may need to be repeated 2-3 and there can be temporary swelling, redness or bruising.
It is not usually painful because we use numbing cream and ice pops.